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Memory clinics under pressure, NHS England dementia lead admits

Exclusive Patients in some areas are facing long waits for dementia assessments in memory clinics, the Government’s dementia tsar has admitted.

Professor Alistair Burns, national clinical director for dementia at NHS England, told Pulse he believes there are some very good examples of diagnostic and support services around the country, but agreed there are some places where the waiting list is ‘longer than it should be’.

In an exclusive interview with Pulse, Professor Burns defended the Government’s commitment to pressing ahead with incentives to raise diagnosis rates, saying it offers the opportunity to ‘shine a light’ on dementia care.

But his comments on memory clinics echoed those of Alzheimer’s Society chief Jeremy Hughes, who told delegates at the Public Health England conference last week of patients in some areas waiting six months to be seen, and again raised questions about the strain placed on both patients and the health service as the new DES for dementia case-finding gets underway.

Much of the controversy over the DES for dementia surrounded the lack of necessary specialist memory clinics as well as treatments and support for patients once they are diagnosed with dementia.

The GPC warned earlier this year that dementia services are already overburdened, and screening could increase ‘false-negatives’ leading to undue anxiety and that screening is not supported by evidence or NICE clinical guidance.

Speaking after a Mental Health Forum debate on the national dementia policy, Professor Burns said that the Royal College of Psychiatrists Centre for Quality Improvement would be releasing an audit next month looking at access to memory clinics.

And he stressed a key ambition of the Government’s National Dementia Strategy is not only to raise the rate of dementia diagnosis from the current estimate of 46% to two-thirds – but also to ensure two-thirds receive adequate post-diagnosis support.

He said ‘This will help shine a light and look at some of the aspects of memory clinics [but] there are some places where the waiting list is longer than it should be.’

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He said CCGs needed to act locally to find solutions where memory clinics faced backlogs: ‘CCGs need to have discussions with the memory clinic to ask what are the reasons for these delays – can we do things in a different way?’

Professor Burns said in his area in South Manchester, specialists have begun running memory clinics within primary care and that his overall aspiration was for GPs to have the skills to diagnose patients with dementia themselves.

He said: ‘That seems to have lots of benefits, the patient gets to see the memory doctor at the GP clinic, which they are happy to do, whereas they might not want to go to the specialist clinic.

He added: ‘Diagnosis is a process that can be done in conjunction with a memory clinic, although one of my aspirations and one of the things that we are working with the RCGP and a number of CCGs around the country is to see by increasing the skills in primary care, that these skills will be there.’

Mr Hughes told Pulse: ‘As more people with dementia seek the timely diagnosis they need to access care and support, we must see improved working between memory clinics and GP practices. Together, they must ensure that there are not long delays in providing a diagnosis’.

Dr Martin Brunet, a GP in Surrey and a leading campaigner against the dementia DES, said that patients were already waiting too long to be seen for a first assessment and the DES would only make this situation worse.

He said: ‘It can only lead to more referrals to memory clinics, and unless there is increased funding to these clinics to match this workload then that can only lead to one of two things: either an increased delay in access to a first appointment, or the diversion of clinic doctors and nurses from follow-up and support of those already diagnosed to assessment services for new referrals.

‘Whenever I go to meetings on the way forward for dementia there is always full agreement that avoiding delays in obtaining a diagnosis and better post-diagnostic support are the top priorities for dementia care. Case finding without extra funding can only have a negative impact on one, or both, of these - and yet the government and many of the expert opinion leaders in the field remain wedded to the idea.’

Readers' comments (9)

Anonymous16 Sep 2013 8:57am

The delay is going to worsen the care of people who the GP is pretty confident have dementia. This is due to saturation of the memory clinics with people who have scored borderline . In the past the GP would have watched these people and not referred straightaway.

it's alright. we can reabsorb all of this work into primary care.we aren't doing any out of hours and we are getting paid lucrative "salaries" (when did this happen?) so we can fit it in when we are loafing between all the other stuff can't we?

That is exactly why all of us , primary and secondary care need to stand up against this government which is only 'good' in talking with political rhetoric with no real sincerity in investing into services to do real work on the frontline .Agent Hunt is so 'good' in using GPs as the hated medium and so shift attention away from the responsibility of re-investing money into the system after all these ruthless , merciless savings .(think about the money going back to the Treasury).Wake up people.....

Now CCG's are responsible for commissioning most of the care for their patients I guess it is upto them how much secondary dementia care is commissioned and how it fits with the other health priorities of their patients.

CCG's need to work this out and then be honest with patients as to why they have prioritied their investments and commissioning.

It's odd isn't it? In a recent MORI poll, GPs remain the top professional that the public trust to tell the truth. Interestingly politicians and journalists are right at the bottom of the list. It's not surprising therefore that they need to bash GPs all the time in an attempt to confuse the public. In my experience the public are in the main a lot more canny than that and see through the rhetoric of the Daily Wail and Hunt.